Long Term Results of Microsurgical Dorsal Root Entry Zonotomy for Upper Extremity Spasticity

OBJECTIVE: The purpose of the present study is to assess the long-term results of microsurgical dorsal root entry zonotomy (MDT) for the treatment of medically intractable upper-extremity spasticity. METHODS: The records of nine adult patients who underwent MDT by one operating neurosurgeon from March 1999 to June 2004 were retrospectively reviewed by another investigator who had no role in the management of these patients. In all patients, MDT was performed on all roots of the upper limb (from C5 to T1) for spasticity of the upper extremity. The degree of spasticity was measured by the Modified Ashworth Scale (grade 0-4). Severity of the pain level was determined using the Numeric Rating Scale (NRS, score 0-10). Also, patient satisfaction of the post-operative outcome was assessed. RESULTS: Comparing the preoperative and postoperative spasticity using the Modified Ashworth Scale, we observed improvement in all patients, particularly in five of the nine patients (55.6%) who improved by three grades over an average of 66.4 months (range, 40-96). Regarding patient satisfaction, seven patients (77.8%) had affirmative results. None of the patients experienced severe, life-threatening, postoperative complications. We observed a decrease in the intensity of painful spasms to less than three scores as measured by NRS in all four patients with associated pain. CONCLUSION: This study shows that MDT provides significant, long-term reduction of harmful spasticity and associated pain in the upper limbs.

The Results of DREZ Operation on Deafferentation Pain

OBJECTIVE: The authors present dorsal root entry zone(DREZ) operations on deafferentation pain patients suffered from brachial plexus avulsion(BPA), phantom pain(PP) and postherpetic pain(PHP). METHODS: Eight patients(Six BPA, one PP and one PHP) underwent DREZ operations on the cervical, thoracic and thoracolumbar spinal cords. The patients were 7 men and 1 woman who were in between thirties and sixties. The lesions were made by inserting 2mm bare tip of standard type DREZ electrode connected to Radionics radiofrequency generator into the DREZ 45 degree off the sagittal plane. The tissue was heated to 75degrees C for 15 seconds. RESULTS: All BPA patients had immediate and long-lasting pain relief regardless of the duration and character of the pain but patients with PP and PHP complained rather aggravation of pain after the operation. CONCLUSION: DREZ operation is effective for BPA pain, however, it needs to have attention in performing this surgery for PP or PHP.